The article, “An Implementation-Focused Qualitative Exploration of Pharmacist Needs Regarding an Opioid Use Disorder Screening and Brief Intervention,” has been published in SAj.

The authors state that screening and brief interventions (SBI) can help identify opioid safety risks and healthcare professionals can accordingly intervene without a significant increase in workload. Pharmacists, one of the most accessible healthcare professionals, are uniquely positioned to offer SBI. To design an effective intervention with high potential for implementation, we explored pharmacist needs and barriers regarding SBI for opioid use disorders.

In the AUTHORS’ OWN WORDS, they relate the importance of their work:

“Prescription-opioid-involved death rates increased by 16% in 2020, despite the declining trend in opioid prescribing rates observed since 2012. While stricter opioid prescribing guidelines have not sufficiently addressed opioid safety concerns, they have also led to opioid access issues. Prevention interventions such as screening, education, prescription monitoring programs, and naloxone dispensing can reduce risky opioid use and promote opioid safety, while ensuring appropriate medication access. Community pharmacists are uniquely positioned to offer opioid use disorder (OUD) prevention interventions due to their high accessibility and medication expertise. Pharmacists can aid in primary prevention of OUD by counseling patients regarding safe medication use and be involved in secondary (screening) and tertiary (harm reduction) prevention. However, in the United States, the role of the community pharmacist in OUD prevention has been limited.”

“The development of a pharmacy-based SBI must incorporate pharmacist views in initial design. This will lead to the development of an intervention that is more feasible for pharmacists to deliver, with greater chance of successful implementation. To design an effective SBI with high potential for implementation, we explored such needs and barriers regarding SBI among community pharmacists dispensing opioid prescriptions. We expected to identify needs such as training to deliver intervention and barriers such as managing time and balancing responsibilities.”

The article, “Predictors and Correlates of Positive Urine Drug Screening in a Retrospective Cohort Analysis of Child and Adolescent Psychiatry Inpatients Throughout the COVID-19 Pandemic,” has been published in SAj.

In this commentary, the authors state youth substance use is associated with significant psychological, neurological, and medical complications. Risk factors for substance use among children and adolescents in the general population include peer and/or parental substance use, certain psychiatric illnesses (eg, Attention-Deficit/Hyperactivity Disorder, depression), and history of maltreatment. Co-occurring substance use and psychiatric illness have been associated with increased suicidality, but few prior studies have characterized substance use among child/adolescent inpatients. As such, it remains unclear how substance use contributing to acute psychiatric presentations has changed since the start of the COVID-19 pandemic.

In the AUTHORS’ OWN WORDS, they relate the importance of their work:

“Given limited data on youth with acute psychiatric needs, the investigators sought to examine substance use in CA patients that were psychiatrically hospitalized. We aimed to determine if the COVID-19 pandemic led to an increased prevalence of positive urine drug screening (UDS) among the CA psychiatric population. The study also aimed to determine if certain sociodemographic or clinical factors increased the likelihood of having a positive UDS. Specific substances tested on routine UDS were examined, including cannabis, opiates, benzodiazepines, and stimulants. We sought to evaluate if any of these factors might independently predict substance use in this population, and, in addition, to examine outcomes, such as length of stay or need for emergency medications for agitation, in patients with positive UDS as compared to those without positive UDS. The study also aimed to compare previously reported substance use with current UDS results.”

“Multiple sociodemographic and psychiatric factors may predispose CA patients to substance use, which can have long-term negative, medical, and psychiatric effects. This study, despite some limitations, is unique in that it compares UDS results to previously reported substance use as well as examines the impact of COVID-19 on substance use among youths in the inpatient psychiatric setting. While our analyses found no impact of the COVID-19 pandemic on UDS results among inpatients, further and more long-term studies are needed. It is crucial to identify and address substance use in the CA population, to prevent future SUDs, improve mental health and psychiatric stability, and to minimize negative structural effects on the brain from substance use.”

The article, “Recruiting and Retaining a Diverse and Skilled Addiction Treatment Workforce,” has been published in SAj.

The authors state that national drug overdose deaths have been rising for decades, with particularly significant increases in recent years among populations of color. There is an urgent need for timely, accessible substance use disorder treatment, but workforce shortages across roles and settings impede the ability of the treatment system to meet the rising and evolving demand. In this commentary, the authors discuss reasons for workforce shortages across roles, and offer recommendations for 8 areas of investment to grow and sustain a substance use and addiction care workforce prepared to address the overdose crisis in a racially equitable manner.

In the AUTHORS’ OWN WORDS, they relate the importance of their work:

“As the overdose crisis has become more concentrated in historically marginalized and underserved populations, there is a growing need for staff who can bridge gaps, build trusting relationships, and make connections to care. Skills in trauma-informed and culturally responsive approaches are critical across roles, and research has also emphasized that people with SUD are most likely to trust and engage with staff who share their racial and cultural identities and/or elements of their lived experiences, including experiences with drug use, recovery, incarceration, and homelessness. However, people of color remain underrepresented in many healthcare occupations and many SUD treatment facilities do not employ peer support specialist staff.”

“To grow and sustain a diverse and skilled substance use and addiction workforce, systems must invest in comprehensive solutions that value and prioritize this field. This includes supporting the frontline staff who are critical points of engagement, while simultaneously developing a robust cadre of culturally responsive treatment providers to ensure that outreach and engagement efforts result in smooth connections to care rather than being bottlenecked by workforce shortages. Many of these changes will require financial resources, which organizations may not currently have, particularly community-based agencies. However, as states prepare to receive billions of dollars in opioid settlement funds, now is the time to consider bold investments.”

The article, “An Assessment of the One-Month Effectiveness of Telehealth Treatment for Opioid Use Disorder Using the Brief Addiction Monitor,” has been published in SAj.

In this commentary, the authors state telehealth treatment with medication for opioid use disorder (teleMOUD) was made possible with regulations following the COVID-19 pandemic that permitted prescribing buprenorphine without an in-person visit. Their study evaluates the self-reported outcomes of patients treated by teleMOUD using the Brief Addiction Monitor (BAM), a 17-question tool that assesses drug use, cravings, physical and psychological health, and psychosocial factors to produce 3 subset scores: substance use, risk factors, and protective factors.

In the AUTHORS’ OWN WORDS, they relate the importance of their work:

“Prior studies evaluating the efficacy of teleMOUD are largely limited to descriptive articles and studies reporting rates of treatment retention. The results of these studies have so far been promising and suggest that teleMOUD is associated with significantly higher rates of retention. Recently, there has been an increase in data evaluating outcomes such as overdose among patients receiving teleMOUD; for example, in one study conducted among Medicare beneficiaries, patients treated in telehealth versus in-person visits had similar rates of medically treated overdose. However, a quantitative assessment of patient improvement with teleMOUD is missing, as is a description of outcomes on a broad variety of patients (ie, not just Medicare, Veterans Affairs, or commercially insured). As the federal government and states weigh permanent changes to permit teleMOUD, evidence to evaluate its efficacy may be helpful.

In this article, we evaluate a cohort of patients treated by a teleMOUD provider using the Brief Addiction Monitor (BAM). BAM is a tool used to systematically monitor patient progress during substance use disorder (SUD) treatment.”

“This study evaluating patient self-reported progress on the BAM instrument found significant improvement in all 3 subscales (substance usage, risk factors, and protective factors) about 1 month after commencing treatment with a single teleMOUD provider. Other recent studies have provided evidence that teleMOUD increases retention in treatment⁶ and improves outcomes¹³ but have not explored the mechanism underlying this improvement. Our results indicate that substance use drops substantially during the first month of treatment and overall risk factors decrease as well.”

The article, “Advocacy for Equity Around Evidence-Based Treatments: Overview and Proceedings of the AMERSA 2023 Conference,” has been published in SAj.

This commentary provides an overview of the 2023 Association of Multidisciplinary Education and Research in Substance use and Addiction (AMERSA) annual conference: Advocacy for Equity Around Evidence-Based Treatments, held from November 1 to 4, 2023, in Washington, DC. The conference featured 9 interactive workshops, 106 oral abstract presentations, and 130 posters. From the pre-conference workshop to plenary sessions, paper, and poster presentations, there was a focus on addressing imbalanced social systems and structures underlying disparities. In the face of increasing drug overdose deaths, diminished access to prevention, intervention, treatment, and recovery supports for racial and ethnic minorities, there is a pressing need for advocacy for equity around evidence-based treatments.

Some conference info & highlights:

As the evidence base related to substance use prevention, intervention, treatment, and recovery supports grows, it is more important than ever to ensure that those resources are equitably distributed. For example, it is well established that drug overdose deaths disproportionately affect people of color, particularly non-Hispanic Black and American Indian/Alaska Native groups. Furthermore, there is evidence that racial and ethnic minorities had buprenorphine access at lower rates compared to White beneficiaries and Medicare recipients. Advocacy is a means of promoting policies that improve health equity, but doing so effectively requires expertise and credibility. Within that context, the theme of the 2023 Association of Multidisciplinary Education and Research in Substance use and Addiction (AMERSA) annual conference was Advocacy for Equity Around Evidence-Based Treatments. This 47th Annual Meeting was held from November 1 to 4, 2023, in Washington, DC. The attendance was the largest to date, with more than 600 participants, over half of whom were first-time attendees.

To increase the representation of people with lived and living experience of substance use, a member-initiated peer recovery workforce special interest group (SIG) was launched at the conference. Most plenary sessions included a speaker with lived experience from peer recovery specialists working in rural Maryland to a mother affected by fetal alcohol spectrum disorder (FASD) to Native American researchers and healthcare professionals. For its annual networking run, AMERSA partnered for the first time with a local chapter of “Back on My Feet,” a running group that aims to empower persons experiencing homelessness, poverty, and/or addiction. “Back on My Feet” is a national organization that helps people overcome addiction and homelessness by offering resources and support through the “power of fitness, community support, and employment resources.

The pharmacist participation at the conference was the highest ever, with 27 pharmacists registered to attend. A pharmacist moderated the AMERSA Discourse, and pharmacists facilitated and delivered several oral presentations and presented posters. Sixteen pharmacists attended the inaugural pharmacists SIG. The mission of SIG is to advance and highlight pharmacist roles and leadership in interprofessional substance use disorder (SUD) care in teaching, scholarship, advocacy, and clinical service teams.